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ELECTRICAL PERMIT APPLICATION <br />CITY OF EVERETT PERMIT SERVICES <br />3200 CEDAR STREET, EVERETT, WA 98201 <br />425-257-8810 - FAX 425-257-8857 -www.everettwa.ory <br />Z�1y i��rrnvc�c A� . _ <br />PROJECTADDRESS <br />� <br />Tenant <br />\�, � ���. <br />Elecirical Contractor <br />Mait Address <br />Mail Address <br />�,�k�r�� �o <br />Ma'�I Address <br />��L�1 TN�L�� N� <br />State License Number <br />Proposed Use of Building <br />Square Footage pf residenlial new construction, remodel or addition) <br />Number of devices (If loH• voltage) <br />Description of Work lo Be Done: <br />CITY OF EVERETT LOCAL SALES TAX CODE IS 3105 <br />Cdy <br />Cily <br />C�ry <br />�� <br />�,�'1.5� � "�-��i - -+�'j � C,� <br />Slale/Zip <br />StalelZip <br />Phone <br />Phone <br />�,Z� � �Z52 - U �'1 " <br />StalelZip Phone <br />Contract Price of Work <br />Contact Person (Plan Review) <br />1 hereby ce�tily that 1 have read and examined this applicafion and kno�v fhe same fo be tnie and <br />correct All provisions ollaws and oNinances goveming this type oI work will6e complefed <br />�vhether specified hercin or noL The yranting ol a pemiif does not pmsume to give aufhonty to <br />violate or cancel the provisions ol any ofhersfafe orlocallaw regulating consfruction or Ihe <br />pedornrance olconsfrucGon. That 1 am aufhonzed Uy fhe ownero/ this pmpeRy lo peAorm fhe <br />work for which application is rnade and 1 comply wifh the Sfafe Con(racfors La�v 18.27 RCW and <br />296 200 WAC. � i <br />��12��1 <br />ar. vrsm v: c�� 3 <br />FEE <br />�� UD <br />PERMIT� <br />E (�fo�f� (So <br />